Sickle Cell Healthcare Plan

SICKLE CELL HEALTHCARE PLAN

Student: Date of Birth:

School: Grade/Teacher/Team:

Goals and School Tips: Prevent/Decrease Sickle Cell Events

1. Maintain adequate hydration, carry water bottle

2. Exercise based on tolerance

3. Avoid extremes in hot/cold temperatures, dress appropriate for weather

4. Staff awareness of signs/symptoms and treatments of sickle cell events.

CIRCLE SYMPTOMS THAT YOUR CHILD MAY PRESENT

DURING A SICKLE CELL CRISIS

Pain: Locations________________________________________________

Fever: What temperature do we call parent?__________________________

Fatigue/Weakness

Pale or Jaundice colored skin

Cough / Shortness of Breath / Increased heart rate

Vomiting/Diarrhea

Unusual behavior/ Refusal to eat/drink

Please note time, duration and intensity, if any of these symptoms occur.

Possible Symptoms Action

1. Fatigue A. Exercise based on tolerance

B. Rest as needed

2. Pain: mild to moderate A. Stop activity and rest

arms/legs/chest/abdomen B. Give fluids/ carry water bottle

C. Warm compresses to site if helpful

D. Medication per parental consent: Medication___________________________

E. Call parents to notify

F. Use coping strategies, divert attention, be calming and reassuring

G. Loosen tight or restrictive clothes

H. Reevaluate pain after comfort measures in place.

3. Severe Pain, swollen and painful A. Call parent, seek immediate medical

Abdomen, pallor, lethargy, possible attention.

Shock, vomiting or diarrhea

4. Fever A. Call parent

B. Over 101 degrees, go home

C. Give fluids

D. Keep in clinic until they go home

Additional Comments:

Parent’s Signature: ___________________________ Health Care Provider________________________

Date:________________________

EMERGENCY CONTACTS:______________________________________________

______________________________________________________________________